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            <head>
                <title>Certification of Enrollment</title>
                <link href="CertificationOfEnrollment.css" rel="stylesheet" type="text/css" />
            </head>
            <body>
                <div style="text-align:center; float: left; width:80%;">
                    <h4>Certification of Enrollment</h4>                        
                    <p style="text-align: center;">
                            Forms returned late may cause a delay in the payment of benefits. Inaccurate/incomplete information my cause delay or termination of your benefits.
                    </p>
                </div>
                <form name ="frmWorksheet">
                    <div style="float:right;">Worksheet Updated: 
                        <br />
                        <input name="UPDATE_DATE" type="text" id="UPDATE_DATE" size="25" disabled="disabled">
                            <xsl:attribute name="value"> 
                                <xsl:value-of select="/page/UPDATE_DATE"/> 
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                        </input>
                        <br />
                        <br />
                            Application Completed Date: 
                        <br />
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                                <xsl:value-of select="/page/ADM_APPL_CMPLT_DT"/> 
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                    <div style="clear:both; padding:20px;"></div>
                    <div class="oneColumn">
                        <p>
                            Indicate semester you are requesting for verification
                            <br />
                            <label for="ddlSemester">Semester</label>
                            <xsl:variable name="Semester"> 
                                <xsl:value-of select="normalize-space(/page/userData/hdnSemester)"/> 
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                            </xsl:element>
                            <label for="txtYear">Year</label>
                            <input type="text" id="txtYear" name="txtYear" size="15" maxlength="4" />
                        </p>
                        <p>
                            <label for="rbChangeFromPreviousRequestNo">Is this a change to a previous request</label>
                            <xsl:element name="input">
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                                <xsl:if test="normalize-space(/page/userData/hdnChangeFromPreviousRequest) = 'Yes'">
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                            <xsl:element name="input">
                                <xsl:attribute name="name">rbChangeFromPreviousRequestNo</xsl:attribute>
                                <xsl:attribute name="id">rbChangeFromPreviousRequestNo</xsl:attribute>
                                <xsl:attribute name="type">radio</xsl:attribute>
                                <xsl:attribute name="value">No</xsl:attribute>
                                <xsl:attribute name="onclick">hdnChangeFromPreviousRequest.value=this.value</xsl:attribute>
                                <xsl:if test="normalize-space(/page/userData/hdnChangeFromPreviousRequest) = 'No'">
                                    <xsl:attribute name="checked">checked</xsl:attribute>
                                </xsl:if>
                            </xsl:element>No
                        </p>
                        <p>
                            <label for="rbCoeSubmittedYes">Have you submitted you Certificate of Eligibility (COE) to the school certifying official at USM</label>
                            <xsl:element name="input">
                                <xsl:attribute name="name">hdnCoeSubmitted</xsl:attribute>
                                <xsl:attribute name="id">hdnCoeSubmitted</xsl:attribute>
                                <xsl:attribute name="type">hidden</xsl:attribute>
                                <xsl:attribute name="value"> 
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                            <xsl:element name="input">
                                <xsl:attribute name="name">rbCoeSubmittedNo</xsl:attribute>
                                <xsl:attribute name="id">rbCoeSubmittedNo</xsl:attribute>
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                            </xsl:element>No
                            <xsl:element name="input">
                                <xsl:attribute name="name">rbCoeSubmittedWaiting</xsl:attribute>
                                <xsl:attribute name="id">rbCoeSubmittedWaiting</xsl:attribute>
                                <xsl:attribute name="type">radio</xsl:attribute>
                                <xsl:attribute name="value">No</xsl:attribute>
                                <xsl:attribute name="onclick">hdnCoeSubmitted.value=this.value</xsl:attribute>
                                <xsl:if test="normalize-space(/page/userData/hdnCoeSubmitted) = 'No'">
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                            </xsl:element>No
                        </p>
                        <p>
                            <label for="txtFullName">Full Name</label>
                            <input type="text" id="txtFullName" name="txtFullName" size="30" />
                        </p>
                        <p>
                            <label for="txtPhoneNumber">Telephone</label>
                            <input type="text" id="txtPhoneNumber" name="txtPhoneNumber" size="30" />
                        </p>
                        <p>
                            <label for="txtEmployeeId">Student ID (MaineStreet ID)</label>
                            <input type="text" id="txtEmployeeId" name="txtEmployeeId" size="30" />
                        </p>
                        <p>
                            <label for="txtMailingAddress">Mailing Address</label>
                            <input type="text" id="txtMailingAddress" name="txtMailingAddress" size="30" />
                        </p>
                        <p>
                            <label for="txtCity">City</label>
                            <input type="text" id="txtCity" name="txtCity" size="30" />
                            <label for="txtState">State</label>
                            <input type="text" id="txtState" name="txtState" size="15" />
                            <label for="txtZipCode">Zip Code</label>
                            <input type="text" id="txtZipCode" name="txtZipCode" size="15" />
                        </p>
                        <p>
                            <label for="txtEmail">Email</label>
                            <input type="text" id="txtEmail" name="txtEmail" size="30" />
                        </p>
                        <p>
                            <label for="ddlBenefitChapter">VA Benefits Chapter</label>
                            <span style="font-size: smaller;">Please verify you have selected the correct chapter as it could delay payment</span>
                            <xsl:variable name="BenefitChapter"> 
                                <xsl:value-of select="normalize-space(/page/userData/hdnBenefitChapter)"/> 
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                                <xsl:attribute name="value"> 
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                                <xsl:attribute name="id">ddlBenefitChapter</xsl:attribute>
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                            </xsl:element>
                        </p>
                        <p>
                            <label for="rbCurrentlyActiveDutyNo">Are you or the veteran currently on active duty</label>
                            <xsl:element name="input">
                                <xsl:attribute name="name">hdnCurrentlyActiveDuty</xsl:attribute>
                                <xsl:attribute name="id">hdnCurrentlyActiveDuty</xsl:attribute>
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                                <xsl:attribute name="name">rbCurrentlyActiveDutyYes</xsl:attribute>
                                <xsl:attribute name="id">rbCurrentlyActiveDutyYes</xsl:attribute>
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                                <xsl:attribute name="name">rbCurrentlyActiveDutyNo</xsl:attribute>
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                                    <xsl:attribute name="checked">checked</xsl:attribute>
                                </xsl:if>
                            </xsl:element>No
                        </p>
                        <p>
                            Program of study at USM
                            <br />
                            <label for="txtDegree">Degree</label>
                            <input type="text" id="txtDegree" name="txtDegree" size="30" />
                            <label for="txtMajor">Major</label>
                            <input type="text" id="txtMajor" name="txtMajor" size="30" />
                        </p>
                        <p>
                            <table border="1px" width="100%" cellspacing="0px" cellpadding="5px">
                                <thead>
                                    <tr>
                                        <td>Course Code (ex. ENG 100C)</td>
                                        <td>Course Title</td>
                                        <td>Credits</td>
                                        <td>Online Course</td>
                                    </tr>
                                </thead>
                                <tbody>
                                    <xsl:for-each select="/page/userData/Courses/ROW">
                                        <tr repeat="row_1">
                                            <td>
                                                <input name="txtCourseCode" type="text" id="txtCourseCode">
                                                    <xsl:attribute name="value"> 
                                                        <xsl:value-of select="txtCourseCode"/> 
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                                            <td>
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                                                    <xsl:attribute name="value"> 
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                                            <td>
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                                                    <xsl:attribute name="value"> 
                                                        <xsl:value-of select="txtCredits"/> 
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                                            <td>
                                                <xsl:element name="input">
                                                    <xsl:attribute name="name">hdnOnlineCourse</xsl:attribute>
                                                    <xsl:attribute name="id">hdnOnlineCourse</xsl:attribute>
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                            <input type="button" name="btnAddRow" id="btnAddRow" value="ADD ROW" repeat="row_1" />
                        </p>
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